Surgeon Explains why Your Doctor is out of Date

TUCSON, Ariz., Sept. 6, 2011 /PRNewswire-USNewswire/ -- Doctors were still prescribing two aspirin a day to prevent heart attacks 20 years after biochemistry research showed that one baby aspirin was the right dose. The higher dose actually works against the beneficial effect.

This situation will only get worse with "best practices" and "evidence-based medicine," writes Dr. Lee Hieb in the fall issue of the Journal of American Physicians and Surgeons. Dr. Hieb, who practices orthopaedic spine surgery in Iowa, is president of the Association of American Physicians and Surgeons (AAPS).

In the past, she notes, physicians faced with novel problems were free to offer treatment they thought might work, based on their understanding of the basic science, their clinical experience, and their judgment, while following the injunction to "first do no harm."

Now, doctors fear to do anything without a paper-trail back-up of published studies. Hieb likens it to the "Processional Caterpillar" effect.

"The Processional Caterpillar is named because of its habit of following a leader. No one knows how the leader is chosen, but before slithering to or from feeding grounds, the unchosen caterpillars form up in a line behind the leader," Hieb writes. "If, however, such caterpillars are placed on the rim of a bucket, the leader will eventually catch the end of the line, conclude he has been replaced, and start to follow the caterpillar in front of him, until they are all going round and round the bucket rim."

Evidence and research are good things, of course. But however well intentioned, "best practices" are leading to consensus-based medicine.

"Consensus is the basis of politics, not science," states Hieb, quoting the late Michael Crichton. Science cannot progress when "suggestions" become Holy Writ, and physicians with contrarian views are ostracized.

"Incredible statistical gymnastics" are applied to collections of studies to produce "meta-analysis papers that resemble numerology more than medicine." Meanwhile, no credit is given to clinical acumen. Yet we do not need a randomized study to assess the value of a parachute when jumping out of an airplane, Hieb notes, citing a tongue-in-cheek British essay.

If patients are not to die unnecessarily or become disabled because of lost opportunities, physicians need the freedom to think and to innovate, without waiting for the herd that's stuck in "standard practice" to catch up.

AAPS, a national organization representing physicians in all specialties, www.aapsonline.org was founded in 1943 to defend the sanctity of the patient-physician relationship.

SOURCE Association of American Physicians and Surgeons (AAPS)

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